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SEP-07-2004 16�50 P.03iO3 <br /> SHORELINE EROSION PROTEC710N - FAST TRAC1K P ��� <br /> ERMIT <br /> MINNEHAHA CREEK VWATERSHEO DISTRICT (MCWD) <br /> GRAY FRESHWATER CEN7ER <br /> 2500 SHADYWOOD ROAD Ph: 952-471-0590 <br /> EXCELSIOR, MN 55331 � Fax: 952-471-0682 <br /> ���► �1'1_--�___�-_5_�'. DYf1 reside at 1'l a5 �r�Cp�,l�. .-�� <br /> (Property Ow er) ' — -- ' --� _ <br /> (5treet Address) <br /> Y01'� V�l� 5539�� ���,��J��9�e q u es t app�va l io install riprap <br /> �----� <br /> (Ciry) ' (State) (Zip) (Phonej , <br /> shoreline erosion protection on prope�ty described as__I�_�J�a�rd,l� <br /> � a;located in <br /> _ �r�� _ _��j � �.�Street addres ) <br /> �-�--�--1 7--)�7��,?��a-A�� The riprap installation <br /> (Within ihe City boundarles) (County) (Property ID# [PIo#]) <br /> will consist of 5d� along the shoreline of�111.11 �,,,, � <br /> (Llneal feet) ��--�� �� ' �--`_" ��flJll <br /> (Lake) �geY� <br /> accordance with the Minnehaha Creek Watershed District Shoreline Protection Guidefine for <br /> riprap placement required far issuance of a Fast 7rack General Permit. I have contracted with <br /> _�C�`N��C I ,�YIC;., _�— ��tJ , 5�'1C3T2,�-1►1��i ���- <br /> Name of Com n � y'�� - g�y� <br /> � Pe Y) t0(Street address) ri�1y) ����p� �� (phone) <br /> J / 0 g � /_ perform the work Jvho is f�m�ar with the echrnca�gy <br /> (Bond Number) � <br /> requirements and has fulfilled the bonding requiremenfis of the watershed district(see page <br /> two). I have read and understand the requirements of the MCWD relating to Shoreline Erosion <br /> Pr 'o�� <br /> � <br /> - __--- v � <br /> ure of Property Owner) '� � (Date <br /> Subscribed and sworn before me on this__��_day of � Zp� <br /> � � -�--^---�-- . �~ , <br /> ��No�ry P b!i 8HERYL <br /> A.LATTEqNER <br /> NOTqF�y PUBLIGMINNEgpTq <br /> MV CpMMIS810N EXpIpE9�,��,� <br /> ■ <br /> Approved by: <br /> Date D <br /> Distn'hutlon: ^Property Owner _„Contraclor _,Munlclpality _ONR <br /> _QistAct File <br /> Page 1 of 2 <br /> TOTRL P.03 <br />